LATE MIGRATION OF AN ORBITAL IMPLANT CAUSING ORBITAL HEMORRHAGE WITH SUDDEN PROPTOSIS AND DIPLOPIA

A 31-year-old woman complained of sudden diplopia and proptosis associ ated with a headache. Approximately 10 years earlier, she had sustaine d a right orbital blowout fracture during a snow machine accident that was repaired using a Supramid implant. She presented with 4 mm of rig ht-sided proptosis by Hertel exophthalmometry with Limitation of up an d down gaze. She manifested a right gaze preference with a left head t urn To achieve fusion. Visual acuity was 20/20 on both sides; however, there was 20% red desaturation and a subtle afferent pupillary defect on the right side. Goldmann visual fields were full and the retinal e xamination was normal. A computed tomography (CT) scan of the orbits w ith and without contrast demonstrated a large right posterior inferior orbital mass. Once the periorbita was breached during orbitotomy, a b urgundy serosanguinous material emerged. Gram staining revealed red ce lls without organisms. The implant had not been fixed by wires or scre ws. Upon removal, the implant appeared oversized, encompassing the orb ital floor, medial and lateral walls. Postoperatively, the proptosis, gale preference with face turn, afferent pupillary defect, desaturatio n abnormality, and diplopia resolved.